20. Against Medical Advice

Profuse salivation after de-ticking by the groomer yesterday. The owner sent the dog to the emergency vet. Dog was given charcoal tablets and sent home. The owner was told to return in 2 to 3 days' time for a blood test.

Yet the dog started to salivate again in the morning. I was consulted. No more ticks. The owner was worried about the salivation and some shivering.

"Did you apply a 'Spot-On' insecticide onto the spinal area earlier?" I asked.
"Yes," the owner said. But ticks were still present and so she went to the groomer to get de-ticking done.
"The groomer must have applied a tick wash," I said. "Did the dog lick his paws and body?"
"Yes," the lady replied. The dog looked all right. There was some wet whiskers seen, due to salivation.

The dog was bathed thoroughly before its coat was clipped short. An IV Hartmann's solution was given. It was bathed again after clipping. Around 1,000 ml of IV drip was given to dilute the poison if possible. The owner wanted the dog home on the same day despite my advice to wait for one day for observation.

So the dog went back at 9 pm. This was one of those cases that should be warded for one or two days for observation, but the owner decided against medical advice and must be respected.

Day After My Treatment
The owner phoned me to say that the dog was not behaving normally. However he was eating and had no vomiting, salivation, shivering or diarrhoea. "It will take around 7-14 days to recover if the insecticide poisoning has not affected the brain, liver and kidneys," I advised.

The groomer phoned me and so I was able to know what had been used. The owner had phoned him earlier and so he phoned me to find out about the dog. He had used 1 cap of the Carrington Dog Wash Concentrate in around 800 ml of water. "No complaints from most owners," he told me. "Except for a few cases of salivation."

"This dog could have licked the insecticide from the matted hairs in its paws," I said. "The owner did not accept my advice to de-matt the paw hairs," the groomer said. So, the insecticide could have accumulated inside the paw's matted hair and the dog could have licked it and started salivating. However salivation is a sign of insecticide poisoning.

This is a case likely to result in negligence complaints and litigation if the dog has died. The vet and groomer have to be very careful nowadays. So far, so good.

P.S.
Carrington Dog Wash Concentrate contains pyrethroid insecticide and is sold in some Singapore pet shops. Not all dogs need to be warded for suspected insecticide poisoning but some dogs such as this case would be advised as the IV drip needs to be given over 24 hours. If owners go against medical advice, give the owner a release form stating that the owner wanted the dog to be discharged immediately and by 9 pm in any case. I did not give the release form in this case and sometimes this omission would haunt me if there was litigation.

Spot-on insecticides are said to be ineffective for some dogs but effective in others. A spot-on insecticide and a tick wash sometimes cause profuse salivation in dogs, depending on dosage. Owners who acted against medical advice should be given a release form to sign to protect the veterinary practice against litigation.